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Date:   01 July, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits.
 
THE COCKER SPANIEL KEEPS SHAKING HIS HEAD DAILY
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
01 July, 2010
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Be Kind To Pets
Veterinary Education
Project 2010-0129
Patient: English Cocker Spaniel, Male, Neutered, 5 years. Gentle dog. No Cocker Rage.
Complaint: Head shaking for several weeks. Dark red ear wax in horizontal canal. Groomer could not resolve this problem.
Solution: I advised surgery to open up the vertical ear canal so that the trapped water and debris inside the canals can flow out easily in the long term. The couple in their 40s knew what I was talking about and agreed to the surgery. 

ANAESTHESIA
Jun 21, 2010. Anaesthesia and Surgery took over one hour.
Pre-anaesthetic dose Domitor 0.25 ml IV. Waited 5 minutes. Isoflurane gas. Intubate. "How about Zoletil IV?" my assistant Mr Saw asked as in the recent debarking case, I had used both.

"It is best not to give more sedation drugs than necessary. I will be using isoflurane which is safest," I advised him. "Less sedation drugs, less likely to get anaesthetic deaths. If I use Zoletil, I will need to use Atropine to prevent salivation and muscle tremors. Then I need to top up as this surgery is going to be longer than debarking as I have two ear surgeries to do. That means I still need isoflurane gas to maintain surgical anaesthesia."

Pre-anaesthetic sedation using one drug and isoflurane gas is the safest method of anaesthesia for dogs and I use this method frequently. In debarking, I had no choice but to use injectable anaesthetics and there was the hassle of topping up via the IV catheter. For gas anaesthesia, just increase the dosage and that is so convenient when the dog is intubated and given gas. For injectable anaesthetic top up, it is given by small doses via the saline drip. It is quite convenient too but nothing is as safe as the isoflurane gas.    

"Any surgery consent forms to sign?" the owner had asked me earlier. "The owner can sign forms for the vet. The important thing is that the dog does not die on the operating table." Usually I assess the dog's health and the owner's personality and I seldom give them forms to sign. But I have always communicated to them the risks of anaesthetic deaths. Consent forms are common even in human anaesthesia and surgery at the Singapore hospitals.

Performance (a live dog at the end of surgery) counts a lot. I cannot be complacent as one anaesthetic death creates massive waves of emotional upheavals in the owners and the family. This English Cocker Spaniel is healthy but still no vet can guarantee the owner that the dog will not die on the operating table.  

SURGICAL PROCEDURE
1. Clipped skin of ear to the base, not just partly. My assistant had to shave more, increasing the anaesthetic time. Put artery forceps to base of vertical canal to identify the location.
2. Draw the outline of the surgical area from base of vertical canal and add 50% more length (see picture).
3. Electro-incision of rectangular outline.
4. Excise subcutaneous fat to see the vertical canal.
5. Be careful of a big vein posterior to the vertical canal. If cut, ligate this vein. Elevate cut skin upwards to see the subcutaneous fat. Also be careful not to excise the branch of a facial nerve and salivary glands on the ventral aspect of the incised area. If the facial nerve is excised, the eye-lids will droop. However, the vet can't see this nerve easily. Know your veterinary anatomy.
6. Angle forceps at 30 degrees downwards and outwards so that the drainage board is wide and clamp anterior and posterior edges of vertical canal.
7. Electro-incision on clamped groove.
8. Scissors to cut.
9. Lower the cartilage. Cut cartilage long enough to anchor it to base of skin. I stitched at the horizontal canal level first. 2/0 absorbable sutures were used.
10. To illustrate the surgical procedures, some pictures are presented below. More pictures of the surgical procedures in other dogs are at:
asiahomes.com/singaporetpvet/dogs/0750Schnauzer_lateral_ear_resection_Singapore.htm
 

cocker spaniel, otitis externa, head shaking, neck scratching, toa payoh vets, singapore cocker spaniel, otitis externa, head shaking, neck scratching, toa payoh vets, singapore  
Before lateral ear resection surgery  
english cocker spaniel, head shaking several weeks, lateral ear canal resection surgery toa payoh vets singapore english cocker spaniel, head shaking several weeks, lateral ear canal resection surgery toa payoh vets singapore english cocker spaniel, head shaking several weeks, lateral ear canal resection surgery toa payoh vets singapore
cocker spaniel, head shaking several weeks, lateral ear canal resection surgery toa payoh vets singapore english cocker spaniel, head shaking several weeks, lateral ear canal resection surgery toa payoh vets singapore english cocker spaniel, head shaking several weeks, lateral ear canal resection surgery toa payoh vets singapore
Lateral ear resection surgery being performed by Dr Sing
  english cocker spaniel lateral ear canal resection surgery otitis externa toa payoh vets singapore english cocker spaniel lateral ear canal resection surgery otitis externa toa payoh vets singapore
  4 days after lateral ear resection surgery. Goes home

POST-OPERATION CARE
Tolfedine painkiller injection after surgery and orally for the next 4 days were quite effective in controlling the pain. Dosage was 4mg/kg whether by injection or oral. An e-collar was given.

I asked the owners to take the dog home on Day 4 to reduce costs for them. Ideally I would like to keep the dog for 10 days to ensure complete healing but there is always the increase in veterinary costs for the owner and this may not be in their interest.

"The left ear has a stitch breakdown on the lower right side," I said to the couple. It will close. Do not wipe the wound. The stitches will dissolve usually. I need to review in 14 days from today."    

Light & Beauty. Singapore flower. Toa Payoh Vets UPDATE AS AT JUN 30, 2010
Some 10 days have passed. No complaints from the dog owner.

More case studies, goto:  Ear Problems in Singapore dogs
or:
Cats  or  Dogs

To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326

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